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Independents' Day

When doctors become patients

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When I was a house officer on a busy medical ward, we had a patient I will always remember in a side room. She was 32, had metastatic breast cancer and was dying. Those were the years before preferred place of death was an option, and everyone died in a hospital bed. Every day I would perform my morphine rounds; crossing out the prescription in her syringe driver and replacing it with a higher dose. I didn’t venture much into that room and neither did the nurses. I knew the patient was likely to be fearful and lonely, yet I found it almost impossible to overcome my anxiety about her illness. You may be wondering what she had done to be so emotionally neglected. Her only crime was that she was a GP.

All GPs know that we make the worst patients, but have we reflected on how we treat sick doctors? Fortunately my only inpatient experience was for childbirth, and I was home within two days. However, I have been the not-so-silent bystander with my husband and children at various appointments and I acknowledge those consultations must have been challenging for the GP.

The difficulty of consulting with doctors is that some of the basic consultation tools, such as eliciting a patient’s ICE, bring an entire three-act play. We have formulated a differential diagnosis, a battery of investigations and a management plan. This is when mutual trust, respect and empathy become crucial. Our consultation models just don’t work for doctors and it’s easy to see how our emotions can be ignored when we become patients. Dr Kate Granger has been an inspiration in this area, highlighting the need for all staff to introduce themselves. I wonder how much of her experiences could be attributed to the fact that she is a member of a group that is often feared and misunderstood by health professionals.

Years ago, Epsom Hospital in Surrey had a private wing that accommodated any sick employee, from the cleaner to the consultant. I doubt this VIP service would happen now. There are still many doctors who will give out personal numbers and email addresses to colleagues and I am grateful to the paediatric GPSI who has done this for my daughter. But I don’t think it is such a straightforward decision for all doctors, especially the younger ones. The boundaries of the doctor-patient relationship are very blurred when you are treating colleagues or their family. We have distinct needs, but these are often ignored or neglected. As a profession, we receive no training on how to manage one another’s health.

I am still ashamed of my immaturity and inability to cope with a dying GP when a houseman and I reflect on how different her experience would be today. Although it is likely she would have been nursed at home by an expert team, I still wonder how prepared they would be to care for one of their own.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (9)

  • Why do sick GPs feel entitled to 'VIP' treatment Nabi?

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  • If you read the blog carefully, you would see that the "VIP" treatment extended to all hospital employees, from cleaner to consultant. In those days, we were all part of a team, GPs included, and professional courtesy was the norm. There are few perks associated with NHS service, and a "private" or "side room" was an acknowledgement of ones contribution. Now we live in a disjointed, corporate vision of the NHS, these small gestures, which encouraged a sense of belonging, no longer exist.

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  • Don't answer trolls! This one is the worst....must work for the daily mail
    Great article by the way leaving aside the nuisance first comment from the *&^&% above. .

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  • It's the expectation of "special treatment" on the part of doctor-patients that leads to situations where doctors are afraid to provide standard care.

    Also why assume that it's only doctor-patients who have thought out their differential diagnoses and the battery of tests they would like to be undertaken? Plenty of patients do this - it's just that non-doctor patients' ideas aren't elicited and welcomed.

    Why always the "them and us"? Why not accept you are human, fallible and vulnerable like the rest of the population?

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  • 9.39 how disrespectful you sound......
    3.11 read the title of this piece........
    Shaba, a lovely poignant piece of writing.
    Please ignore the trolls, and keep up the great work.

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  • Lovely piece of writing as usual Shaba. Ignore the ignoramuses.

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  • Good article Shaba. I think that many clinical staff have been guilty of similar avoidance strategies as juniors and one can only hope that it is something that we learn to recognise and take responsibility for during training. It's interesting to see that the negative commentators are reluctant to reveal their identities...

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  • fantastic peice

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  • Why is it that anyone who takes up an alternative stance or opposes popular opinion is automatically a Daily Mail reading "Troll?"

    Sometimes this site is excellent but sometimes it's damn frustrating.

    Liberal elite condemning the Liberal elite who then join forces when someone has an opinion that doesn't match theirs.

    Hypocrisy at its best (or worst) depending on your "opinion"

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